Tachycardia During Augmentin Therapy
Primary Assessment
First, determine if this tachycardia is related to Augmentin or represents an independent cardiac arrhythmia requiring immediate intervention. Augmentin (amoxicillin/clavulanate) is not known to cause tachycardia as a direct adverse effect, so this heart rate elevation likely represents either an underlying infection-related response or a primary cardiac rhythm disturbance 1, 2.
Immediate Clinical Evaluation
Assess hemodynamic stability immediately by checking for hypotension, altered mental status, signs of shock, chest pain, or acute heart failure symptoms 3, 4.
- If the patient is hemodynamically unstable, proceed directly to synchronized cardioversion without delay for further diagnostic workup 5, 3
- If the patient is hemodynamically stable, obtain a 12-lead ECG to determine if this is sinus tachycardia versus a pathologic tachyarrhythmia 3
Distinguishing Sinus Tachycardia from Arrhythmia
Sinus tachycardia (100-115 bpm) is the most likely diagnosis in a patient on antibiotics, as it typically represents a physiologic response to infection, fever, dehydration, or pain 1, 6.
If Sinus Tachycardia:
- Treat the underlying cause rather than the heart rate itself 3
- Evaluate for fever, infection severity, volume depletion, pain, or anxiety 1, 6
- Continue Augmentin as prescribed, as the antibiotic is treating the underlying infection that may be driving the tachycardia 1, 7
- No specific cardiac intervention is needed for physiologic sinus tachycardia in this range 3
If Supraventricular Tachycardia (SVT):
For stable narrow-complex regular tachycardia, initiate vagal maneuvers immediately as first-line therapy 5, 3. If vagal maneuvers fail, adenosine 6 mg IV rapid push is the recommended first-line pharmacologic agent, with approximately 95% success rate in terminating AVNRT 5, 3.
- If adenosine fails or SVT recurs, intravenous beta blockers, diltiazem, or verapamil are reasonable second-line options 5, 3
- These agents are effective in 80-98% of cases for acute termination 5
Critical Considerations with Augmentin
There are no documented cardiovascular contraindications or interactions between Augmentin and standard antiarrhythmic medications 1, 2, 7.
- Augmentin can be safely continued during treatment of tachyarrhythmias 1, 7
- The antibiotic does not interfere with adenosine, calcium channel blockers, or beta blockers 1
Common Pitfalls to Avoid
Do not discontinue Augmentin based solely on tachycardia, as the infection being treated may be the underlying cause of the elevated heart rate 1, 6, 7.
- Do not delay cardioversion to obtain diagnostics in unstable patients - hemodynamic stability takes absolute priority 3
- Avoid calcium channel blockers (verapamil, diltiazem) if wide-complex tachycardia is present, as this may represent ventricular tachycardia and could worsen hemodynamics 5, 4
- In patients with asthma or COPD, avoid adenosine due to risk of bronchospasm 5, 4
Ongoing Management
If the tachycardia resolves with treatment of the underlying infection, no further cardiac intervention is needed 1, 6. If a primary tachyarrhythmia is confirmed, oral beta blockers, diltiazem, or verapamil are recommended for ongoing management in patients without contraindications 5, 3.